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 24,271 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gestational diabetes mellitus is a substantial and growing health concern in many parts of the world. Certain populations are especially vulnerable to developing this condition because of genetic, social, and environmental factors. Gestational diabetes has serious, long-term consequences for both baby and mother, including a predisposition to obesity, metabolic syndrome, and diabetes later in life. Early detection and intervention can greatly improve outcomes for women with this condition and their babies. Unfortunately, screening and diagnostic tests are not uniform worldwide, which could lead not only to underdiagnosis but also undermanagement of the illness. Here, we report the controversies surrounding the causes, screening, diagnosis, management, and prevention of gestational diabetes, and give specific recommendations for research studies to address the major issues of this medical condition.
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PMID:Gestational diabetes: the need for a common ground. 1971 59

Human pregnancy is characterized by insulin resistance, traditionally attributed to the effects of placental hormones. Normal pregnancy-induced insulin resistance is further enhanced in pregnancy complications, associated with disturbed placental function, such as gestational diabetes mellitus, preeclampsia, and intrauterine growth restriction. Compelling evidence suggests that these pregnancy disorders are associated with future development of maternal metabolic syndrome. However, the pathogenetic mechanisms underlying the association between abnormal placental development, insulin resistance, and maternal metabolic syndrome are not fully understood. A large body of evidence has recently supported the role of adipose tissue in the regulation of insulin resistance in both nonpregnant and pregnant participants. In this respect, adipocytokines, which are adipocyte-derived hormones, have been implicated in the regulation of maternal metabolism and gestational insulin resistance. Adipocytokines, including leptin, adiponectin, tumor necrosis factor alpha, interleukin 6, as well as the newly discovered resistin, visfatin, and apelin, are also known to be produced within the intrauterine environment. However, data concerning the pattern of adipocytokines secretion in normal and complicated pregnancies are still limited and partially contradictory. Given the importance of adipose tissue and its hormones in terms of adequate metabolic control and energy homeostasis, we present a review of published data related to the role of adipocytokines in pregnancy, especially in relation to pregnancy complications. Focus will be placed on the functions and other potential roles of the novel adipocytokines resistin, visfatin, and apelin.
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PMID:Reviews: adipocytokines in normal and complicated pregnancies. 1947 87

Gestational diabetes mellitus (GDM), defined as carbohydrate intolerance of any degree first recognized during pregnancy, complicates approximately 4% of all pregnancies in the United States. Several factors can increase one's risk of developing GDM, including obesity, family history of type 2 diabetes mellitus (T2DM), and race/ethnicity. Conversely, a history of GDM can increase the risk of developing not only T2DM but also cardiovascular disease (CVD) independent of a diagnosis of T2DM. Several investigations have explored GDM relationships with CVD risk factors, CVD surrogate markers, and clinically evident CVD. These studies have included evaluations of biochemical parameters, such as inflammatory and endothelial biomarkers; endothelial dysfunction, such as that seen in impaired brachial artery flow-mediated vasodilation; and vascular dysfunction, manifest as cardiac dysfunction or in diseases such as hypertension. This article will review these studies and examine factors considered to be responsible for promoting CVD in women with a history of GDM, such as T2DM and metabolic syndrome and its components. In addition, studies evidencing CVD in women with a history of GDM will be explored.
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PMID:Late cardiovascular consequences of gestational diabetes mellitus. 1953 66

Excess bodyweight is the sixth most important risk factor contributing to the overall burden of disease worldwide. In excess of a billion adults and 10% of all children are now classified as overweight or obese. The main adverse consequences of obesity are the metabolic syndrome, cardiovascular disease and type 2 diabetes and a diminished average life expectancy. It has been argued that the complex pathological processes underlying obesity reflect environmental and genetic interactions, and individuals from disadvantaged communities seem to have greater risks than more affluent individuals partly because of fetal and postnatal programming interactions. Abundant evidence indicates that the obesity epidemic reflects progressive secular and age-related decreases in physical activity, together with passive over-consumption of energy dense foods despite neurobiological processes designed to regulate energy balance. The difficulty in treating obesity, however, highlights the deficits in our current understanding of the pathophysiology which underlies the initiation and chronic nature of this disorder. Large population based studies in Europe and North America in healthy women and in women with gestational diabetes have demonstrated that there are clear relationships between maternal and fetal nutrient supply, fetal growth patterns and the subsequent risk of obesity and glucose intolerance in childhood and adult life. In this review we discuss the impact of fetal nutrition on the biology of the developing adipocyte and brain and the growing evidence base supporting an intergenerational cycle of obesity.
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PMID:The early origins of later obesity: pathways and mechanisms. 1953 65

Gestational Diabetes Mellitus (GDM) can have serious immediate as well as long term consequences, both for the mother as well as the off-spring. It seems that women of south Asian origin are not only more likely to have GDM but also suffer more from the adverse consequences of the disorder. These consequences include the development of type 2 DM in women with a history of GDM and a higher risk of obesity and metabolic syndrome in the off-spring. Pakistani physicians should consider GDM seriously because the WHO states that rise in the prevalence of type 2 DM will mainly occur in developing countries such as ours. Since GDM can lead to development of type 2 DM, efforts should be made to prevent type 2 DM through lifestyle modification strategies in this high risk population. It is important that we develop some clear cut guidelines for prevention and treatment of GDM.
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PMID:Gestational diabetes mellitus--a forerunner of chronic disorders in mother and child. 1957 40

In preeclampsia, there is exacerbation of physiological changes associated with pregnancy such as insulin resistance, altered immune responses and inflammatory pathway activation. These exaggerated responses seen in preeclampsia are reminiscent of metabolic syndrome, and also are evident in gestational diabetes mellitus. The link between these phenomena is not clear but novel findings providing some insight have been reported recently. Inositol phosphoglycan P-type (P-IPG) in preeclampsia has been extensively investigated and increased production has been demonstrated. This molecule acts as a second messenger of insulin, enhances the metabolic effects of insulin and is associated with insulin resistance. This review article summarizes current evidence of the role of inositol phosphoglycans in the metabolic syndrome that occurs in preeclampsia, discussed in the light of modifications found in gestational diabetes mellitus and diabetes type 2 in pregnancy in humans and animal models. An increase in urinary release of P-IPG during pregnancy may herald the onset of preeclampsia. Further knowledge about the nature of the metabolic syndrome during preeclampsia and the degree of association between its components will help to inform future research efforts and to identify biochemical markers that could help in clinical practice, for example early markers that will have utility in managing disease progression.
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PMID:The link between insulin resistance and preeclampsia: new perspectives. 1962 83

The parallel epidemics of obesity and Type 2 diabetes (T2DM) are progressing rapidly in Australia. The high prevalence of obesity and sedentary lifestyle in the population, compounded by later child bearing, has led to an increase in the prevalence of T2DM pre-dating pregnancy. In some centers, pregnant women with T2DM now outnumber those with type 1 diabetes (T1DM). Although there is controversy as to whether T2DM is associated with worse outcomes than T1DM in pregnancy, modern reports clearly acknowledge the seriousness of this condition. There is a clear association between obesity and adverse pregnancy outcomes (cesarean section, gestational diabetes, hypertensive disorders, birth defects and prematurity). Aside from obesity and the metabolic syndrome, additional factors may contribute to these adverse outcomes: A lack of preconception planning, a failure to achieve tight glycaemic control early in pregnancy and socio-economic disadvantage. It's likely that obesity and diabetes have compounding effects on pregnancy outcomes. In this review, we evaluate both the underlying pathogenesis of T2DM and obesity in the pregnancy context and the adverse clinical maternal and perinatal outcomes described in pregnancies complicated by maternal T2DM and obesity. We highlight the need for a comprehensive strategy to improve clinical outcomes in these pregnancies.
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PMID:Pregnancy in type 2 diabetes mellitus--problems & promises. 1968 54

Diabetic men have benefited in the last 30 years from a significant improvement in total and cardiovascular mortality, whereas diabetic women have had no improvement at all. Moreover, recent research focused on the role of sex hormones in glucose homeostasis, and might account for different pathophysiologic mechanisms in the development of diabetes-related complications. Thus, care of diabetic women is a challenge that requires particular attention. The available data regarding gender-specific care of diabetes mellitus are uneven, rich in some domains but very poor in others. The large prospective trials performed in the last 20 years have assumed that the natural history of diabetes mellitus in men and women, as well as the efficiency of glucose-lowering therapies and management of hyperglycemic-related complications, could be attributable without distinction to men and women. We propose in this paper to analyze the published medical literature according to the specific management of diabetes mellitus in women, and to try to distinguish some particular features. We found important distinctions between diabetic men and women regarding the patterns of abnormalities of glucose regulation, epidemiology, development of diabetes-related complications, ischemic heart disease, morbidity and mortality, impact of cardiovascular risk factors, development of the metabolic syndrome, depression and osteoporosis, as well as the impact of lifestyle modifications or primary and secondary preventions on cardiovascular risk factors, and finally medical therapeutics. Moreover, special considerations were given to some particular aspects of the medical life in diabetic women, such as the features of gestational diabetes mellitus and the management of pregnancy in pregestational diabetic women, use of contraception, hormone-replacement therapy and polycystic ovary syndrome.
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PMID:Gender-specific care of diabetes. 1980 83

The aim of this study was to examine the association between plasma retinol-binding protein 4 (RBP4) and gestational diabetes mellitus (GDM) and the risk of developing metabolic syndrome after pregnancy. In a case-control study, 192 pregnant women (92 with GDM) were recruited. Gestational diabetes mellitus was diagnosed based on O'Sullivan and Mahan criteria. In all pregnancies, plasma RBP4 concentrations were measured. Retinol-binding protein 4 concentrations in GDM patients were significantly higher than the normal women. Retinol-binding protein 4 level equal to or more than 42 microg/mL could help predict the risk of developing GDM (sensitivity = 75.8%, specificity = 65.3%, P = .001). Concerning metabolic syndrome after pregnancy, in all participants, the prevalence of metabolic syndrome base on World Health Organization (WHO) criteria was 24%. After pregnancy, 32.6% of women with GDM had metabolic syndrome compared with 10.5% of those with healthy pregnancy (P = .001). Age more than 25 years, body mass index (BMI) more than 27 kg/cm(2), and RBP4 concentrations were independent risk factors for GDM. Measurement of RBP4 together with the assessment of other risk factors could help identify women at risk of developing GDM.
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PMID:Association between retinol-binding protein 4 concentrations and gestational diabetes mellitus and risk of developing metabolic syndrome after pregnancy. 1989 88

Gestational diabetes mellitus (GDM) is a type of diabetes that presents during pregnancy and usually disappears shortly after a woman gives birth. Better recognition of the risk factors of GDM, combined with more universal screening for the disease in many countries, has led to the increased detection of GDM along with other forms of pregestational diabetes. There is growing evidence that GDM significantly increases the risk of a number of short- and long-term adverse consequences for the fetus and mother, the most significant of which is a predisposition to the development of metabolic syndrome and Type 2 diabetes. Maternal and childhood obesity as well as cardiovascular disease are also potential long-term consequences of GDM. On the other hand, there is a growing body of evidence suggesting that the risk of many of these consequences can be significantly reduced or eliminated by aggressive treatment of GDM. There remains, however, a great deal of controversy over when to begin screening for hyperglycemia in pregnancy and at what level of hyperglycemia should aggressive intervention be initiated.
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PMID:The fetal and maternal consequences of gestational diabetes mellitus. 2195 80


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